By Lesley Young
If there’s one thing all parents agree on, it’s that they would do and try anything to help their sick child. For many, this includes the use of complementary and alternative medicine (CAM). In fact, studies show that up to 50 percent of parents are using alternative medicines such as vitamins and chiropractic care on their children. Both a “pull” motivation (an eagerness to make the best choices for their kids) and a “push” motivation (desperation in dire situations) are driving Canadian families to put their faith in CAM, according to Dr. Sunita Vohra, an associate professor in the department of pediatrics at the University of Alberta in Edmonton. “Indeed, many families with chronically ill children will use CAM,” she says. Once families have tried alternative medicines, this much appears to be true: they are won over by the time and attention provided by CAM practitioners.
The challenge, say the experts, is that research shows up to half of these parents aren’t telling their doctors when they consult CAM practitioners, and in some cases, may fail to disclose the information because they fear negative reactions. “A minority of mainstream doctors will recommend one kind of CAM or another to their patient families, but their reasons for doing so can vary from belief in efficacy to simple compassionate use,” says Dr. Lloyd Oppel, an emergency physician and vice-chair of the council on health promotion at the British Columbia Medical Association in Vancouver. “It’s important to remember that CAM is an umbrella term covering hundreds of modalities, from telepathic healing to lifestyle modification. Most doctors do not buy into CAM as a package. Most are concerned about it (as is the scientific community).” Dr. Oppel studies the research on CAM, not only as both a practicing physician and father of an autistic child, but also because he chairs a scientific panel that examines the evidence behind alternative therapies. In addition, for the last six years Dr. Oppel has taught a course on statistics and research appraisal at the University of British Columbia, and has a graduate degree in that area. He says he just isn’t convinced it has any value. However, he concedes there is a divide between mainstream and alternative medicine that could end up alienating families.
Recognizing that families exploring CAM need the best information and care possible, Dr. Vohra founded a first-of-its-kind integrated clinic in Canada called PIM (Pediatric Integrative Medicine), run through Edmonton’s Stollery Children’s Hospital. At the clinic, individual patients are assessed by team members appropriate to their needs; usually the team consists of a pediatrician (Dr. Vohra herself) or nurse practitioner, pharmacist/dietitian/social worker as per their needs and one CAM provider — for example, a traditional Chinese medicine (TCM) practitioner, naturopath or massage therapist. “Our goal is to make sure parents aren’t making decisions in the dark,” explains Dr. Vohra. At the same time, the two-year-old clinic is shining a light on the need for trust between families and all their healers.
PIM is unique for two reasons: it offers CAM within a children’s hospital outpatient clinic, and the CAM it offers is evidence-based. Dr. Vohra explains, “We look for existing evidence, and build new evidence with each patient seen. We certainly prefer high-quality evidence (such as randomized controlled trials [RCTs] or systematic reviews) but do not limit ourselves to this.” CAM is often dismissed by conventional medicine due to a belief that supporting research does not exist, says Dr. Vohra. And yet she cites one study that uncovered 908 RCTs on pediatric CAM.
“People make assumptions before they look. That’s why research is such a big part of our clinical program — we look.” Dr. Vohra adds that there’s no reason not to incorporate clinical evidence (practitioners’ experiences with patients or anecdotal evidence) on CAM in a heath-care decision. “When families come back they are presented with information from both sides — evidence-based and clinical — and the team comes together. That’s what makes it integrated, and the family is not forced into the middle of a tug-of-war.”
Time, or lack of it, is affecting families’ perceptions of conventional medicine, concedes Dr. Mark Sherman, a family doctor who also practises CAM at the James Bay Community Project in Victoria. He admits that his situation — he is salaried — enables him to take the time both to learn about CAM and to spend a little longer consulting with families, which is necessary to create the trusting, respectful environment so integral to a healing relationship. But he notes that his approach is rare among colleagues. “It’s something our current fee-for-service model — that in some practices seems more like a revolving door — is not allowing. I believe lots of doctors would like to have more time with patients. And I would like to see a system that encourages physicians to be healers again, and honour their therapeutic relationship.”
On the one hand, Dr. Oppel agrees that conventional doctors do need to be open to different attitudes and cultural preferences toward CAM. However, he also says that modern medicine can be delivered with the compassion that draws so many families to CAM. “But compassion is not the same as misinformation. Within organized medicine, we’ve come to realize that if you cut corners on evidence, you’re almost certainly to fall through thin ice. You’ve got to make decisions based on the best information possible.”
Here’s how three different families found CAM, and experienced varying degrees of the ongoing tug-of-war between mainstream science and alternative healing.
The Gagnon/Lacoste family’s experience
For Mélanie Gagnon, the choice to treat her two-year-old daughter Delphine Lacoste’s cold and flu bugs with nothing but rest, lots of fluids and homeopathic remedies is based on a belief system. Ottawa-based Gagnon was exposed to homeopathy at a young age by her mother, who uses it in conjunction with standard treatments, for her own asthma. Homeopathy was first introduced to the medical community in 1796; the Canadian Society of Homeopaths defines it as “a natural system of medicine that uses highly diluted doses of substances to stimulate the body’s own healing mechanism to promote health.”
It’s just a different way of looking at things. When Delphine is sick and has a runny nose, I don’t give her stuff to make her nose stop running. I want it to run its course. I want to let the body do what it is supposed to do.” A homeopathic practitioner was also the only person Gagnon could talk to about her fears of vaccination when she was pregnant who didn’t think “I was nuts or putting my baby in danger.”
What appears to be at stake for families torn between mainstream and alternative medicine is trust. Gagnon, for example, was relieved to find someone who would simply talk with her about her worries that vaccinations might cause more harm than good. She had read stories that suggested there are links between vaccinations and increased risk of allergies and even autism. She says that unlike her GP, her homeopathic doctor walked her through both the benefits and potential risks, and together with her husband, Sébastien Lacoste, they decided not to immunize their daughter.
Public health authorities, including Health Canada, contend vaccinations are safe. And mainstream medicine experts, including Dr. Oppel, are concerned that more decisions such as Gagnon and Lacoste’s could result in a resurgence of some serious diseases, including polio. Gagnon, who, believes her daughter builds an immunity by risking exposure and acknowledges this is contrary to the arguments for vaccinations made by mainstream medicine, says, “I believe that vaccines do not confer actual immunity; rather they suppress the body’s own reactions to viruses and bacteria.”
Jason Busse, a research associate at McMaster University, has conducted studies that show that child patients of naturopaths tend to have lower rates of vaccination than the average population. He believes there are two forces at play: some parents who are less likely to embrace vaccinations and who seek out CAM, which in most cases, reinforces their beliefs; and some parents who are influenced by what he says is a bias against vaccinations in the CAM community.
The bottom line is that Gagnon has more confidence in her homeopathic doctor, and says that she consults her before visiting a GP with any concerns she has about Delphine’s health. Dr. Vohra points out why neutrality, which is an underpinning of the PIM clinic, is so important in any health-care relationship. “We are neither for CAM or against it, but about it. We are trying to promote evidence-based decision making, in a field that often suffers from emotional-based decision making.”
The McKinnon-Drumm family’s experience
Lisa McKinnon-Drumm in Hillsdale, Ont., was at her wit’s end. Her son Ethan, 11 months old at the time, had a cough that just wouldn’t go away, despite three rounds of antibiotics. She had been seeing a chiropractor for the past 12 years to treat a back injury, and one day mentioned her frustrations about treating Ethan’s cough. The chiropractor told her to bring him in.
A test showed several of Ethan’s vertebrae were not sitting correctly, and within a month of receiving spinal adjustments, McKinnon-Drumm says the cough improved noticeably. “There was even some instant improvement.” She also took son Hayden at five weeks to treat him for the first signs of colic (Hayden is now 6-½ months old). It has been about three years since Ethan’s first adjustment, and now she takes both boys to receive regular maintenance adjustments. When asked if she was ever worried about harming her children, she says, “I can see Hayden’s so happy afterward. People think they take your head and whip it around; it’s not like that.”
Chiropractors contend there is a relationship between the spine and the nervous system that affects many of the body’s functions. Barrie, Ont.-based chiropractor Dr. Liz Anderson-Peacock says, “They examine children to ensure optimum neuromusculoskeletal integrity and function.” Chiropractors can also alleviate many of the symptoms expressed with asthma and colic, although they don’t purport to diagnose or cure those illnesses. (See CAM Safety on second last page)
The tug-of-war families experience between conventional doctors and CAM practitioners is perhaps most pronounced over the use of chiropractic care for children, also the CAM most commonly used by families. In a 2002 paper, the Canadian Paediatric Society encouraged physicians to engage in open and honest discussions with families about their use of chiropractic care, noting one study that showed less than 50 percent of families told their physicians about using it.
One thorny issue exacerbating the ongoing divide between doctors and chiropractors is the use of vaccinations. Some chiropractors have been outspoken against them, and a few years ago the Canadian Chiropractic Association reminded all practitioners that “the public responsibility for vaccination and immunization is neither within the chiropractic scope of practice, nor a chiropractic-specific issue.” Around the same time, a 2005 U.S. study showed that a majority of pediatricians would discharge families from their practice if they refused to vaccinate their children. Both examples suggest there is little room for discussion on either side.
Vaccination is not something McKinnon-Drumm discusses with her chiropractor — she had both her boys vaccinated. Rather, she is now confident that regular chiropractic adjustments are the best preventive health care strategy she can undertake for her boys. “My chiropractor spends hours with us, if need be, going over everything.” And while they still make annual trips to the family GP, she adds, “I actually find the general practitioners so busy, they don’t have time to look at everything.”
The Drader family’s experience
For Bobbi-Dawn Drader, alternative medicines such as acupressure and herbs offer hope where modern science is failing to alleviate the ravaging affects of juvenile rheumatoid arthritis in her five-year-old daughter Raegan. Frequent pain and swelling caused by inflammation in all of Raegan’s joints prevent her from bending properly, walking and even sitting upright at times. Two years of conventional treatments — namely anti-inflammatory prescription drugs — weren’t managing the chronic disease, says Drader, based in Edson, Alta. And in February 2007, after Raegan, then four years old, experienced a sudden severe bout of stiffening, Drader and her husband Dion decided they had to try something else.
Drader heard about the PIM clinic and, worried about Raegan’s worsening condition, booked an appointment through her pediatric arthritis specialist in the summer of 2007. The clinic requires a referral, says Dr. Vohra, because its goal is to improve communication between families and their doctors. “We want to encourage families to talk about CAM with the people who are looking after them.”
In their initial three-hour consultation, the Draders met with Dr. Vohra, a dietitian, a pharmacist and then the CAM provider of their choice, in their case a traditional Chinese medicine (TCM) practitioner. They discussed their daughter’s case with each expert, and also brought up various remedies they had read about on the Internet: for example, could cutting tomatoes out of Raegan’s diet help? Should they try a natural anti-inflammatory herb? They were so keen to get Raegan started on laser acupressure, they didn’t wait for the consultation results: a 10- to 12-page information package that answered all their questions (which they have since received).
The Draders have continued on with the laser acupressure, although they were disappointed to see no immediate improvement initially. But as treatment has continued, they have noticed some pain reduction and are still hopeful that, with time, they will see greater results.
“We are so much better off than we were on our own. Now we have somewhere to go for support when we want to try new things,” says Drader. “It’s very hard for Western-medicine doctors to stray from what they are trained for. So it’s very nice to have somebody you can trust tell you what is safe and not safe.”
Lesley Young is a Newmarket, Ont.-based freelance writer who looks forward to a time when mainstream medicine is better integrated with CAM across Canada.
Always tell your doctor about any alternative medicines you are trying. If you experience some resistance, be open to what your doctor has to say, says Dr. Sunita Vohra, associate professor, department of pediatrics at the University of Alberta in Edmonton. Here’s a brief outline of the more common CAM treatments and safety considerations.
*There are reports of adverse events for each of these CAMs. The Ministry of Health and Long-Term Care recently passed legislation to regulate the professions of naturopathy, homeopathy and traditional Chinese medicine, but it will be a number of years until the framework to govern these professions is established. Whether or not a healing modality is recognized and regulated varies from province to province. For example, naturopathic doctors in Ontario, British Columbia, Saskatchewan and Manitoba are regulated. Naturopathic doctors in other provinces, not yet regulated, are working to move their profession from the margins to the centre of the health care system.
However, regulation is by no means a stamp of efficacy. Reams of research exist on all sorts of herbs and alternative therapies and their impact on certain illnesses. Your best bet is to ask your doctor to look into what you’re interested in. If you are seeing CAM providers, check to make sure they are members of a college or association, and read their codes of conduct before heeding their advice.